Rural residents can't access health care in a county full of doctors

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Even though Orange County is home to a major North Carolina hospital, some rural residents still have limited access to health care.

These rural areas are typically concentrated in the northern part of the county. A 2015 report by the Orange County Health Department and Healthy Carolinians of Orange County listed lack of medical insurance, clustered health care resources in the south, inadequate transportation, language barriers and perceived discrimination as primary causes of this health care disparity.

“Access encompasses a number of factors including availability, affordability, adequacy and the like,” said Mark Holmes, director of the Cecil G. Sheps Center for Health Services Research at UNC. “When we talk about access in Orange County, different elements may impact different parts of that continuum.”

Holmes said while the gap between northern and southern Orange County is not as bad as other health disparities in the state, the problems occur on a more individual basis.

“There's a lot of areas in the state that have strong health care systems. The problem is reaching the last mile and also providing baseline primary care,” said John Coggin, director of advocacy at the N.C. Rural Center. “Even if you have a hospital within an hour or two hours of your home, that doesn't necessarily mean that you can get that constant level of care you might need.”

An October 2018 draft of the Orange County Public Transportation Short Range Transit Plan, where the local governments try to pinpoint what improvements can be made and identify areas of unmet demand, contained a full section on rural transit services. Nelson\Nygaard Consulting Associates worked on the draft and submitted a finalized plan with GoTriangle for November 2018 that cut the section, as well as all instances of the word “rural.”

The draft suggested a number of options, including expanded bus routes and partnerships with ride-share services and vanpool programs. Both reports included vanpool programs, but the final draft limited this to northern Durham County.

Coggin said that even with increased transportation, many people will not have adequate insurance coverage. North Carolina is part of a minority of states that have not expanded Medicaid coverage under the Affordable Care Act, but he sees this as a potential solution.

“If we're able to close the health insurance coverage gap in North Carolina, it's going to give access to a lot more people in our rural areas, and it's going to help stabilize our rural health care system,” Coggin said.

The UNC Center for Latino Health is one program seeking to resolve the issue of language barriers. While it doesn’t operate in rural Orange County, the center provides specialized care for Spanish-speaking patients in Chapel Hill.

“If a Latino patient is looking for a doctor and doesn't speak a single word in English, that's a big barrier,” Program Manager Claudia Rojas said. “We have some pre-med undergrad students learn a little more Spanish with the Latino community so they seem more confident speaking Spanish with the community. This is a big plus for non-English-speaking patients.”

Coggin said another potential remedy to this issues is the expansion of telehealth programs. By allowing patients to connect to doctors online, they can work around language and transportation barriers. He admits this is not a perfect solution — many areas across the state lack reliable internet, and web programs can’t deliver all the same treatments that a doctor can in person.

Still, these initiatives may alleviate some of the pressures for people in rural areas.

While Orange County has a high ratio of doctors to people, Holmes warns against considering county statistics as representative of the area.

“What's lost in that is that southern Orange County looks quite different from northern Orange County, and by considering the county as a whole, we may lose visibility on parts of it that may face different kinds of challenges,” Holmes said.

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